POS0910 PSYCHIATRIC COMORBIDITIES ASSESSMENT: AN UNMET NEED IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES?
Authors: C. Cardelli, M. Diomedi, S. Barsotti, M. DI Battista, A. Tripoli, L. Carli, M. Mosca
Journal: Annals of the Rheumatic Diseases (2022)

Background Idiopathic Inflammatory Myopathies (IIMs) are rare and complex chronic diseases, with a strong impact on patients’ Quality of Life (QoL) in terms of both physical and emotional functioning. Despite its key role in daily life, patients’ emotional status could be difficult to be investigated by physicians. As known, patients with chronic conditions are at higher risk of anxiety and depression, but data about their prevalence in IIMs are still limited. The Hospital Anxiety and Depression Scale ( HADS ) is a validated questionnaire to evaluate the presence and severity of both anxiety (HADS-A) and depression (HADS-D) in patients. Objectives To determine the prevalence of anxiety and depression in a monocentric cohort of IIMs patients and to evaluate possible correlations with clinical features, disease activity and parameters of QoL. Methods Consecutive adult patients with a diagnosis of IIM (2017 EULAR/ACR criteria) were recruited during a scheduled follow-up visit. Demographic and clinical features were recorded (sex, age, disease subset and duration, organ involvement, comorbidities). IIM disease activity was evaluated following International Myositis Assessment &amp; Clinical Studies Group Disease Activity Core Set Measures. To detect anxiety and depression status, HADS was administered to patients, who were also asked to fill in Short-Form 36 Items Health Survey (SF-36). For both HADS-A and -D subscales, patients were classified as at risk for scores ≥8 (borderline for scores 8-10, high risk if ≥11). Results were reported as mean±SD for continuous variables and as percentage for categorical variables. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. Pearson coefficient was used to analyse the correlations between variables. P values &lt;0.05 were considered significant. Results Fifty-three patients (72% female; mean age 64.8±12.0 years; mean disease duration 7.4±6.2 years) were enrolled. Twenty (37.7%) showed increased anxiety scores (mean 11.35, min. 8 – max. 17): 10 (50%) borderline and 10 (50%) high risk. Twenty (37.7%) had an increased depression score (mean 11.75, min. 8 – max. 19): 6 (30%) borderline and 14 (70%) high risk. If abnormal scores of both HADS-A and -D were found in 15 patients (28.3%), 17 patients (32.1%) were at high risk of at least one of the conditions. Sex, age, disease subset and duration did not seem to influence patients’ emotional status. Apart from an association between Raynaud’s Phenomenon occurrence and higher HADS-A scores ( p =0.045), no significant correlations with organ involvements emerged. A strong association was found between fibromyalgia and higher HADS-A and -D scores ( p =0.006 both). Patients with elevated anxiety levels presented significantly higher scores of Patient Global Assessment (PGA, p =0.002) and Health Assessment Questionnaire (HAQ, p =0.007) and significantly lower scores of Manual Muscle Testing (MMT8, p =0.004). HADS-D scores were similarly associated with PGA ( p =0.001), HAQ ( p &lt;0.0001) and MMT8 ( p =0.001). The presence of anxiety and depression was associated with lower scores in all SF-36 domains (all p ≤0.016 for HADS-A and all p ≤0.006 for HADS-D). Moreover, a correlation was found among SF-36 scores and PGA (all r &lt;-0.516, p &lt;0.01), HAQ (all r &lt;-0.541, p &lt;0.01) and MMT8 values (all r &gt;0.299, p &lt;0.05). Conclusion These results show nearly 40% of our cohort was at risk of anxiety or depression; almost 30% were at risk of developing both conditions together and quite one third was at high risk to develop at least one of them. As expected, these conditions were favoured from a concomitant fibromyalgia. Moreover, a compromised QoL and a functional limitation, as evaluated by PGA, HAQ and MMT8, in agreement with SF-36 domains, were significant risk factors for their occurrence. Therefore, our data, although preliminary, underline the need of a more comprehensive evaluation of IIMs patients, who should be screened for psychiatric comorbidities and, in case of high risk, referred to a specialist evaluation, in the perspective of improving their quality of care. Disclosure of Interests None declared